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In alignment with previous literature, NICU parents reported experiencing racism and NICU staff reported witnessing racism in the NICU. Our study also uniquely describes personal experiences with racism by staff in the NICU. NICU staff reported witnessing and experiencing racism more often than parents reported. Black staff reported witnessing and experiencing more racism than white staff. Differences in reporting is likely influenced by variations in lived experience, social identities, psychological safety, and levels of awareness. Future studies are necessary to prevent and accurately measure racism in the NICU.

BACKGROUND: Posttraumatic stress (PTS) and anxiety are common mental health problems among parents of babies admitted to a neonatal unit (NNU). This review aimed to identify sociodemographic, pregnancy and birth, and psychological factors associated with PTS and anxiety in this population. METHOD: Studies published up to December 2022 were retrieved by searching Medline, Embase, PsychoINFO, Cumulative Index to Nursing and Allied Health electronic databases. The modified Newcastle-Ottawa Scale for cohort and cross-sectional studies was used to assess the methodological quality of included studies. This review was pre-registered in PROSPERO (CRD42021270526). RESULTS: Forty-nine studies involving 8,447 parents were included; 18 studies examined factors for PTS, 24 for anxiety and 7 for both. Only one study of anxiety factors was deemed to be of good quality. Studies generally included a small sample size and were methodologically heterogeneous. Pooling of data was not feasible. Previous history of mental health problems (four studies) and parental perception of more severe infant illness (five studies) were associated with increased risk of PTS, and had the strongest evidence. Shorter gestational age (≤ 33 weeks) was associated with an increased risk of anxiety (three studies) and very low birth weight (

OBJECTIVE: Selective serotonin reuptake inhibitor (SSRI) use is common in pregnancy. It is associated with delayed neonatal adaptation. Most previous studies have not adjusted for the severity of maternal mental health disorders or examined the impact of SSRI type and dosage. We examined whether treatment with SSRIs in late pregnancy (after 20 weeks) is associated with delayed neonatal adaptation independent of maternal depression and anxiety. DESIGN, SETTING AND PATIENTS: Retrospective population-based birth cohort of 280 090 term infants born at 15 Kaiser Permanente Northern California hospitals, 2011-2019. Individual-level pharmacy, maternal, pregnancy and neonatal data were obtained from electronic medical records. EXPOSURE: Dispensed maternal SSRI prescription after 20 weeks of pregnancy. MAIN OUTCOME MEASURES: Delayed neonatal adaptation defined as a 5 min Apgar score ≤5, resuscitation at birth or admission to a neonatal intensive care unit for respiratory support. Secondary outcomes included each individual component of the primary outcome and more severe neonatal outcomes (pulmonary hypertension, hypoxic-ischaemic encephalopathy and seizures). RESULTS: 7573 (2.7%) infants were exposed to SSRIs in late pregnancy. Delayed neonatal adaptation occurred in 11.2% of exposed vs 4.4% of unexposed infants (relative risk 2.52 (95% CI 2.36 to 2.70)). After multivariable adjustment, there was an association between SSRI exposure and delayed neonatal adaptation (adjusted OR 2.14 (95% CI 1.96 to 2.32)). This association was dose dependent. Escitalopram and fluoxetine were associated with the highest risk of delayed neonatal adaptation. CONCLUSIONS: Infants exposed to SSRIs have increased risks of delayed adaptation in a type and dose-dependent relationship, pointing toward a causal relationship.

The survival of preterm infants has steadily improved thanks to advances in perinatal and neonatal intensive clinical care. The focus is now on finding ways to improve morbidities, especially neurological outcomes. Although antenatal steroids and magnesium for preterm infants have become routine therapies, studies have mainly demonstrated short-term benefits for antenatal steroid therapy but limited evidence for impact on long-term neurodevelopmental outcomes. Further advances in neuroprotective and neurorestorative therapies, improved neuromonitoring modalities to optimize recruitment in trials, and improved biomarkers to assess the response to treatment are essential. Among the most promising agents, multipotential stem cells, immunomodulation, and anti-inflammatory therapies can improve neural outcomes in preclinical studies and are the subject of considerable ongoing research. In the meantime, bundles of care protecting and nurturing the brain in the neonatal intensive care unit and beyond should be widely implemented in an effort to limit injury and promote neuroplasticity. IMPACT: With improved survival of preterm infants due to improved antenatal and neonatal care, our focus must now be to improve long-term neurological and neurodevelopmental outcomes. This review details the multifactorial pathogenesis of preterm brain injury and neuroprotective strategies in use at present, including antenatal care, seizure management and non-pharmacological NICU care. We discuss treatment strategies that are being evaluated as potential interventions to improve the neurodevelopmental outcomes of infants born prematurely.

Adrenal insufficiency (AI) is a life-threatening disorder. Defects at any level of the hypothalamic-pituitary-adrenal axis can impair adrenal function. It is difficult to make a diagnosis of AI in the newborn because during the neonatal period clinical findings are not specific and range from insidious, nonspecific complaints to circulatorycollapse due to hypovolemic shock. Another condition when is difficult to make a diagnosis of AI is in critically ill patients. There is no consensus on which patients to test for AI, which tests to use and how to interpret them. In this evidence-based review we aim to provideinformation for the evaluation of adrenal function results and findings in both the neonatal period and critical illness in childhood and adolescence. [ABSTRACT FROM AUTHOR]

Low birth weight and anemia are significant public health challenges in developing countries. This study seeks to evaluate the relationship between hemoglobin levels during the first and second trimesters of pregnancy and the occurrence of low birth weight, while accounting for potential confounding factors. This multi-center cross-sectional study was conducted among all pregnant women with COVID-19 and with no history of receiving the COVID-19 vaccine who delivered in public and private hospitals in three counties, Mahabad, Miandoab, Bukan in Iran, using routinely collected maternity and health data on pregnancies. Hemoglobulin levels were measured during the first (6–10th weeks) and second (24–28th weeks) trimesters of pregnancy, and pregnancy outcomes were recorded in the health information system. Hb levels were categorized into four groups as follows: ≥110 g/L, 100–109 g/L, 90–99 g/L, and < 90 g/L for the first trimester and ≥ 105 g/L, 100–104 g/L, 90–99 g/L, and < 90 g/L for the second trimester. Multivariable logistic regression analysis determined the association between hemoglobin levels during pregnancy and low birth weight. P-values < 0.05 were considered statistically significant. A total of 385 mothers with COVID-19 were included. The mean age of COVID-19 pregnant women was 30.01 ± 6.24 years. After multivariable adjustment, Hb levels < 110 g/L in the first trimester had a significant association with low birth weight [OR, 4.13; (95% CI 2.11–8.10)]. Morevoer, Hb levels < 105 g/L in the second trimester was a significant association with low birth weight [OR:3.91; (95% CI:1.98–7.75)]. Maternal anemia during pregnancy, including first and second trimesters, was a significant association with Low birth weight even after adjusting for common confounders. Effective management and monitoring of anemia in pregnant women, particularly in low- and middle-income countries, are crucial for preventing low birth weight. [ABSTRACT FROM AUTHOR]

Background: Despite international guidelines for lung protective ventilation in neonatal or pediatric acute respiratory distress syndrome (nARDS/ pARDS), prospective data on bedside monitoring tools for regional ventilation distribution and lung mechanics are still rare. As a bedside and radiation-free procedure, electrical impedance tomography (EIT) offers a practical and safe approach for analyzing regional ventilation distributions. Recent trials in adults have shown the efficacy of an individualized EIT guided strategy for the improvement of ventilator induced lung injury (VILI). Methods: We performed a single-center prospective feasibility study from November/2021 to December/2023 in the department of neonatal and pediatric intensive care medicine at the University Children´s Hospital in Bonn. All patients with diagnosis of nARDS (or history of perinatal lung disease-PLD)/ pARDS were screened for study inclusion. In all patients a decremental PEEP (positive end-expiratory pressure) trial was performed with a continuous EIT monitoring for an individual analysis of the EIT guided pixel compliance (CEIT) and PEEP finding (EIT-PEEP). In the offline analysis, further EIT derived indices, such as global inhomogeneity index (GI), and center of ventilation (CoV), were calculated. Results: Overall, 40 EIT measurements were performed in 26 neonatal and pediatric patients (nARDS/PLD, n = 6; and pARDS, n = 20) within a predefined decremental PEEP trial. Thirteen patients were classified as having severe nARDS (PLD)/ pARDS with an Oxygen Saturation Index (OSI) > 12 or Oxygenation Index (OI) > 16. In-hospital mortality rate was 27% in the overall cohort. The median EIT-PEEP (11mbar) was calculated as lowest, as compared to the clinically set PEEP (11.5mbar, p < 0.001), and the ARDSnetwork PEEP table recommendation (ARDSnet-PEEP, 14mbar, p = 0.018). In patients with nARDS/PLD, the EIT-PEEP was calculated 3mbar below the clinically set PEEP (p = 0.058) and 11 mbar below the ARDSnet-PEEP (p = 0.01). In the linear regression analysis, EIT-PEEP and the dynamic compliance (CDYN) at -2mbar presented a significant correlation with a Cohen´s R2 of 0.265 (β: 0.886, p = 0.005). Conclusion: EIT is feasible and can be performed safely in patients with diagnosis of nARDS/PLD and pARDS, even during ongoing extracorporeal membrane oxygenation (ECMO) support. An individualized PEEP finding strategy according to the EIT compliance might optimize regional ventilation distribution in these patients and can potentially decrease VILI. Clinical trial registration: The study was registered at the German Clinical Trials Register (GCT; trial number: DRKS 00034905, Registration Date 15.08.2024). The registration was performed retrospectively after inclusion of the last patient. [ABSTRACT FROM AUTHOR]

Purpose: Managing hydrocephalus in infants can be very challenging. The most used permanent hydrocephalus treatment in young patients is a ventriculoperitoneal shunt (VPS) placement. Obstructive hydrocephalus in selected young patients can be treated with endoscopic third ventriculostomy (ETV). However, in infants less than 6 months of age, the outcome of both procedures remains to be bothered with complications, revision surgeries and long-term shunt dependency. This retrospective study analyzes the management of hydrocephalus in 54 very young infants with different etiological causes. Methods: Data was collected retrospectively from a single center university hospital over a 5-year period (2018–2022). All patients under 3 months of age with progressive ventriculomegaly confirmed by cranial ultrasound (cUS), who required neurosurgical intervention, were eligible for this study. Hydrocephalus was treated with serial tapping from a ventricular access device (VAD), placement of ventriculoperitoneal shunts and/or performing a thulium laser-assisted ETV. Results: Twelve patients benefited sufficiently from a VAD to normalize ventricular volume lastingly. Forty-two patients required permanent treatment (28 underwent a VPS; 14 an ETV if there was obstructive hydrocephalus) at an average age of 2.5 months. The VPS failure rate was 32.1% and the ETV failure rate was 50%. Although not significantly different, patients with failed ETV tended to be younger than patients with successful ETV (p = 0.38). One week before permanent ETV treatment, relatively large ventricular volumes were measured in failed ETV patients, as compared to successful ETVs. Conclusions: Managing hydrocephalus in very young infants remains challenging regarding surgical strategy, reducing shunt dependency and decreasing current complication rates. In addition to a VPS, an ETV has shown to be a successful treatment option for hydrocephalus in well-selected very young infants. The opportunity to decrease ventricular volume with a VAD could have contributed to the success of an ETV in this young patient group. [ABSTRACT FROM AUTHOR]

Background: Yemen is the poorest and war-torn country in the North Africa and Middle East region and lacks a comprehensive assessment of temporal trends in the overall disease burden, injuries, and disabilities at the country level; these insights are required to guide healthcare interventions and improve overall population health. We estimated the burden and temporal trends of diseases and their risk factors in Yemen between 1990 and 2021 using data from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2021. Methods: In this systematic analysis, we presented all-causes and cause-specific mortality rates, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), as well as the life expectancy at birth and health-adjusted life expectancy (HALE) using the standardized GBD methodology. Moreover, we compared the disease burden of Yemen with the top five war-torn countries based on the Global Peace Index (GPI) 2021, including Afghanistan, Syria, South Sudan, and Iraq. Results: In Yemen, the life expectancy at birth increased from 59.0 years (95% UI 56.4–61.8) in 1990 to 65.3 years (95% UI 62.2–67.9) in 2021. Between 1990 and 2021, the all-causes age-standardized mortality rate in Yemen decreased from 1471.7 deaths (95% UI 1268.4-1696.3) to 1347.2 deaths (95% UI 1097.5-1659.5). However, the age-standardized mortality rate caused by conflict and terrorism substantially increased from 1.9 deaths (95% UI 1.7–2.1) to 50.0 deaths (95% UI 45.5–55.0) between 2010 and 2021. In 2021, ischemic heart disease, COVID-19, stroke, hypertensive heart disease, conflict and terrorism, and neonatal disorders were leading causes of age-standardized mortality and YLLs rate. Dietary iron deficiency, low back pain, depressive disorders, headache disorders, anxiety disorders, and gynecological diseases were the leading causes of age-standardized YLDs rate in 2021. High blood pressure, high levels of low-density lipoprotein, smoking, low birth weight, and short gestations were the leading risk factors for age-standardized mortality in 2021. Yemen ranked 3rd in terms of high age-standardized all-causes deaths, YLLs, and lowest HALE at birth and lowest life expectancy at birth among the top five war-torn countries in 2021. Conclusion: Yemen must proportionately address the burden caused by non-communicable diseases, communicable, maternal, neonatal, and nutritional diseases, and conflict and terrorism. Prioritizing these areas will improve the overall population health and prevent premature mortality and disabilities. [ABSTRACT FROM AUTHOR]

Background: Neonatal mice are frequently used to model diseases that affect human infants. Microbial community composition has been shown to impact disease progression in these models. Despite this, the maturation of the early-life murine microbiome has not been well-characterized. We address this gap by characterizing the assembly of the bacterial microbiota of C57BL/6 and BALB/c litters from birth to adulthood across multiple independent litters. Results: The fecal microbiome of young pups is dominated by only a few pioneering bacterial taxa. These taxa are present at low levels in the microbiota of multiple maternal body sites, precluding a clear identification of maternal source. The pup microbiota begins diversifying after 14 days, coinciding with the beginning of coprophagy and the consumption of solid foods. Pup stool bacterial community composition and diversity are not significantly different from dams from day 21 onwards. Short-read shotgun sequencing-based metagenomic profiling of young pups enabled the assembly of metagenome-assembled genomes for strain-level analysis of these pioneer Ligilactobacillus, Streptococcus, and Proteus species. Conclusions: Assembly of the murine microbiome occurs over the first weeks of postnatal life and is largely complete by day 21. This detailed view of bacterial community development across multiple commonly employed mouse strains informs experimental design, allowing researchers to better target interventions before, during, or after the maturation of the bacterial microbiota. The source of pioneer bacterial strains appears heterogeneous, as the most abundant taxa identified in young pup stool were found at low levels across multiple maternal body sites, suggesting diverse routes for seeding of the murine microbiome. 9CunmNp3_d6oLBRK9YAPEH Video Abstract [ABSTRACT FROM AUTHOR]

Most brain development occurs in the "first 1000 days", a critical period from conception to a child's second birthday. Critical brain processes that occur during this time include synaptogenesis, myelination, neural pruning, and the formation of functioning neuronal circuits. Perturbations during the first 1000 days likely contribute to later-life neurodegenerative disease, including sporadic amyotrophic lateral sclerosis (ALS). Neurodevelopment is determined by many events, including the maturation and colonization of the infant microbiome and its metabolites, specifically neurotransmitters, immune modulators, vitamins, and short-chain fatty acids. Successful microbiome maturation and gut–brain axis function depend on maternal factors (stress and exposure to toxins during pregnancy), mode of delivery, quality of the postnatal environment, diet after weaning from breast milk, and nutritional deficiencies. While the neonatal microbiome is highly plastic, it remains prone to dysbiosis which, once established, may persist into adulthood, thereby inducing the development of chronic inflammation and abnormal excitatory/inhibitory balance, resulting in neural excitation. Both are recognized as key pathophysiological processes in the development of ALS. [ABSTRACT FROM AUTHOR]

Background: Clinical empathy is an essential part of healthcare, and patient-centered care models require clinical empathy to be established. Despite this, little is known about its measurement in the neonatal scenario. Research Aim: To measure clinical empathy in health professionals who work with medium and high-risk neonates and build a construct of this empathy. Research Design: Single-center survey study. Participants and Research Context: The Jefferson Scale of Empathy for Health Professionals questionnaire was applied to health professionals who work in an intensive care unit and a medium-risk unit, in Brazil. Analysis was done using descriptive statistics and a factor analysis model, to build the construct of empathy. Overall empathy was calculated, and the domains' punctuations were analyzed and compared to the maximum punctuation possible. The study followed the STROBE checklist. Ethical Considerations: This study was approved by the Research Ethics Committee of the institution. All participants signed the informed consent form. Participants' confidentiality and anonymity were protected. Findings: Median empathy was 117 (IQR 113–124). The domain of Walking in the Patient's Shoes had lower scores and represented 77.6% of the maximum punctuation possible. The factor analysis included three factors named Understanding, Experiences, and Treatment, and Emotional Relationships, explaining 64.3% of the overall variance. The domain Walking in the Patient's Shoes was not included in the model. Conclusions: In this scenario, clinical empathy should improve. There is a need to improve the domain of Walking in the Patient's Shoes, in this case, the neonate, and provide more empathic care to them. [ABSTRACT FROM AUTHOR]

Background: The percentage of preterm infants requiring surgery before 44 weeks of postmenstrual age (PMA) varies between 19% and 36%. The potential impact of general anesthesia on the vulnerable developing brain of preterm infants remains unknown. Methods: A systematic review and meta-analysis on the impact of general anesthesia on brain integrity and neurodevelopmental outcomes in preterm infants undergoing surgery before 44 weeks PMA was conducted. Studies were identified via a PubMed, EMBASE (Ovid), and Cochrane CENTRAL search conducted from inception until 8 March 2023, following PRISMA guidelines. Brain abnormality was assessed using MRI-based brain volume and abnormality scores. Neurodevelopment was evaluated through Bayley Infant and Toddler Development (BSID) or Wechsler Preschool and Primary Scale of Intelligence (WPPSI) tests. Quality was assessed via the Cochrane ROBINS-I tool and GRADE. Results: Our systematic search identified 2883 records, leading to the inclusion of 12 observational studies. Very low-quality evidence suggests that preterm infants exposed to anesthesia were more likely to show postoperative brain abnormalities on MRI (OR 2.01, 95%CI 1.24–3.25, p = 0.005). They had lower neurodevelopmental scores on the BSID II and III (psychomotor developmental index: mean difference (MD) −10.98; 95%CI −12.04 to −9.91; p < 0.001 and cognitive composite score: (MD) −10.11; 95%CI −11.06 to −9.16; p < 0.001 at two years of age compared to preterm infants not exposed to anesthesia. Conclusion: Exposure to surgery and anesthesia before term age is associated with brain abnormalities and neurodevelopmental delay at two years, but conclusions are limited by low evidence quality, uncontrolled confounders, and the methodological biases of the included studies; thus further robust studies are required (PROSPERO:CRD42021255907). [ABSTRACT FROM AUTHOR]

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Background: Neonatal advanced practice providers (APPs) often work prolonged hours in high-acuity neonatal intensive care units (NICUs). It is imperative to understand how fatigue affects the APP's ability to react quickly following long shifts. There is a lack of data on the effects of shift length and fatigue on neonatal APP job performance and clinical decision-making. Purpose: The purpose of this study was to describe the variation in shift length, knowledge-based competency, personal well-being, and behavioral alertness for neonatal APPs. Methods: This study evaluated neonatal APPs before and after a clinical shift. Provider well-being was assessed during the pre-survey. Pretest-posttest surveys evaluated neonatal APP's psychomotor vigilance skills and knowledge. Participants completed an online, anonymous questionnaire to answer a series of knowledge-based questions before and after their shift, along with a psychomotor vigilance test (PVT). A paired t test analysis evaluated the pre- and post-shift PVT values and knowledge-based test scores. Results: Overall, 61 pre-surveys and 42 post-surveys were completed; 36 were matched by participants pre- to post-survey. The mean between pre- and post-knowledge-based questions was statistically significant, with higher posttest scores. There was no statistical difference noted in the paired t test analysis of the PVT values. Implications for Practice and Research: The small sample size may limit the generalizability of findings, but these results may indicate that shift length does not affect psychomotor vigilance or knowledge-based competency. It is vital that future work assess the associations between APP shift length, fatigue, and critical decision-making. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical characteristics associated with the presence of LSV at birth. Design: Prospective 1:1 case–control study. Setting: Two tertiary neonatal units in Athens, Greece. Patients: Premature neonates (≤36 weeks gestational age) who underwent cerebral ultrasound within the first 3 weeks of life, where LSV was detected. Main outcome measure: Associations between LSV and clinical characteristics at birth. Both unmatched and matched analyses stratifying the study population by gestational week were conducted. Two-sided p-values were computed using the likelihood ratio test. Results: This study included 166 participants (83 cases and 83 controls). Neonates with LSV exhibited more concurrent cerebral findings, notably periventricular echogenicity. LSV was correlated with higher z-scores for head circumference and body length. LSV was not associated with congenital CMV. Conclusions: This study indicated a relationship between LSV and increased head circumference and body length. Further research is warranted to explore LSV's pathophysiological mechanisms. [ABSTRACT FROM AUTHOR]

Preterm birth represents a nutritional emergency and a sudden dissociation of the maternal–placental–fetal unit that regulates metabolic and endocrine physiology. Growth demonstrates health and is a signal of physiological well-being. Growth is expensive for a critically ill infant and possible only after other homeostasis energy demands are met. Despite an expert-stated goal that preterm infants should grow at a similar rate to their gestational age-matched fetal counterparts, this is not the reality for many preterm infants. Other investigators have proposed new metrics for growth quality in the neonatal intensive care unit. This review discusses growth assessment and standards in very-low-birth-weight infants and attempts to address the knowledge gap of which growth metrics are the most important to monitor. [ABSTRACT FROM AUTHOR]

Background: Despite considerable research on pregnancy outcomes affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the consequences for infants exposed to the virus in utero remain unclear. Methods: A retrospective cohort study was conducted, encompassing 392 mother–infant pairs delivered between April 2020 and July 2021 at a community hospital network in northeastern Pennsylvania, USA. Of these, 198 mothers had a confirmed SARS-CoV-2 infection during pregnancy, while 194 did not. Infant outcomes were compared between the two groups. Results: Pregnant women with a SARS-CoV-2 infection during their gestation exhibited higher rates of obesity (p = 0.04) with higher body mass indices (BMI) (p = 0.01), were more likely to be of Hispanic ethnicity (p = 0.01), and had a history of chronic hypertension (p = 0.05), as well as higher occurrences of postpartum depression (p = 0.01), gestational diabetes (p = 0.05), cesarean section (CS) rates (p< 0.001), and preeclampsia (p = 0.04). Among the infants reviewed, there was no statistical significance difference in developmental milestones at 2, 4, 6, 9, and 12 months of age between infants of parturients who tested positive for coronavirus disease 2019 (COVID-19) and infants of parturients without a positive COVID-19 test result. There was no statistically significant difference between the two groups in developmental outcomes, as measured by Ages and Stages Questionnaire (ASQ) scores at 9 months (p = 0.76) and at 18 months (p = 0.89). Conclusions: This study corroborates the adverse impact of SARS-CoV-2 infection on pregnant women, characterized by increased maternal comorbidities and adverse birth outcomes. No significant disparities in neonatal developmental milestones or growth outcomes were observed at birth; first office visit, or at 1, 2, 4, 6, 9, and 12 months of age. [ABSTRACT FROM AUTHOR]

Background: Digestive disorders are one of the main health problems in suckling piglets. The correct visual identification of feces in suckling piglets is an important tool for the diagnosis of enteric diseases. The aim of the present observational study was to analyze different physicochemical parameters of the feces of suckling piglets aged 0 to 21 days: visual appearance (color and consistency), fecal dry matter (FDM) content and pH. A total of 482 fecal samples were collected and visually classified into six categories: meconium, colostrum stage feces and 4 further scores according to the degree of consistency: 0 = form; 1 = pasty; 2 = liquid; and 3 = watery feces. The percentage of FDM was estimated by two drying methods, oven and microwave, doing duplicates in each one to evaluate methods, and both were compared. Results: The most frequent colors of each feces category were dark green or dark brown for meconium; orange for colostrum; formed feces were mostly ocher and for the rest of the feces, the colors varied predominantly cream and ocher. Regarding FDM, liquid and watery categories had no statistically significant differences between them; meconium and colostrum feces FDM were not statistically different from pasty feces. The correlation coefficient between the FDM values of the duplicate analyses of the samples by both methods (oven and microwave) was very high (> 0.988). Importantly, no differences were found while comparing the results between both methods (p = 0.078), and the correlation coefficient between all samples analyzed with both methods was very high (> 0.98). Meconium was the only one that differed significantly from the rest in terms of pH. Conclusion: The physicochemical study of the feces of suckling piglets including color, FDM and pH allowed the establishment of an objective fecal score to characterize the stools in this age group. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate the incidence of fever in critically ill pediatric patients receiving continuously infused dexmedetomidine. METHODS This was a retrospective study of pediatric patients admitted to the pediatric or neonatal intensive care unit (PICU or NICU) between November 2017 and December 2021 who received dexmedetomidine. The primary endpoint was defined as a fever =38°C while receiving dexmedetomidine. Patient- and drugspecific characteristics between the fever and non-fever groups were compared to identify possible trends. RESULTS A total of 151 patients were included, with a median age of 15.8 months (IQR, 2.9-48.1). Thirteen patients (8.6%) met the criteria for the primary endpoint, with a mean maximum temperature of 38.2°C ± 0.2°C. Median time of fever onset was 9.7 hours (IQR, 2.0-29.3) into their dexmedetomidine infusion with a median dose of 0.4 mcg/kg/hr (IQR, 0.2-0.6). Patients within the fever group were younger (1.7 months [IQR, 1.1-8.6] vs 17.3 months [IQR, 3.3-65.5], p = 0.0006), reached a higher maximum infusion rate (0.8 mcg/kg/hr [IQR, 0.6-0.9] vs 0.6 mcg/kg/hr [IQR, 0.4-0.8], p = 0.0343), and received dexmedetomidine for longer durations (83.2 hours [IQR, 64.2-128.3] vs 35.2 hours [IQR, 17.6-55.7], p < 0.0001) than the non-fever group. CONCLUSIONS Fever =38°C was observed in 8.6% of PICU and NICU patients receiving dexmedetomidine. Younger patients or those exposed to higher doses or longer durations of dexmedetomidine may be at increased risk. Prospective studies will be required to further validate these findings. [ABSTRACT FROM AUTHOR]

When infants cannot directly breastfeed after birth, mothers are advised to initiate lactation through mechanical expression. Families are recommended to target an expression volume of at least 500–750 mL by Day 14 after birth, as this is considered a 'critical window' to establish milk supply. This is challenging for many mothers after a very preterm birth. This article explores the relationship of early milk quantity and later full breastmilk feeding as a 'gold standard' outcome, using statistical techniques designed for diagnostic tests. A cohort of 132 mothers of infants born at 23 + 0 to 31 + 6 weeks' gestational age submitted expressing logs on Day 4, 14 and 21 after birth and provided later feeding outcome. Using receiver operating characteristic (ROC) analysis, the following 24‐h milk quantities were identified as associated with high probability of full breastmilk at 36 weeks' post‐menstrual age (PMA): on Day 4, ≥250 g (specificity 88%; positive predictive value 88%) and on Day 21 ≥650 g (specificity 88%; positive predictive value 91%). The following values were identified as associated with low probability of full breastmilk at 36 weeks' PMA: on Day 4 <50 g (sensitivity 92%; negative predictive value 72%) and on Day 21 <250 g (sensitivity 90%; negative predictive value 70%). Participants exceeding the high thresholds had 3–4 times increased likelihood of full breastmilk, whereas those below the low thresholds had 3–5 times lower likelihood. These thresholds have potential as targets for families, to provide individualised prognostic information and to help clinicians target more intensive lactation support. Key messages: Mothers of very preterm infants who expressed at least 250 g at day four after birth had a high probability of providing later full breastmilk: 88% (95% CI: 72%–97%). This was similar for those who expressed at least 650 g at Day 21: 91% (95% CI: 77%–98%).Mothers of very preterm infants who expressed less than 50 g at day four after birth had a low probability of providing later full breastmilk: 28% (95% CI: 10%–53%). This was similar for those who expressed less than 250 g at Day 21: 30% (95% CI: 12%–54%).These thresholds may be useful for families to understand their lactation trajectories and for clinicians to target support. [ABSTRACT FROM AUTHOR]

Farber disease (FD) is an ultrarare, autosomal-recessive, lysosomal storage disorder attributed to ASAH1 gene mutations. FD is characterized by acid ceramidase (ACDase) deficiency and the accumulation of ceramide in various tissues. Classical FD patients typically manifest symptoms including lipogranulomatosis, respiratory complications, and neurological deficits, often leading to mortality during infancy. Cardiac abnormalities in several FD patients have been described; however, a detailed examination of cardiac pathology in FD has not been conducted. Here we report pronounced cardiac pathophysiology in a new P361R-FD mouse model of ACDase deficiency that we generated. P361R-FD mice displayed smaller hearts, altered cardiomyocyte architecture, disrupted tissue composition, and inclusion-containing macrophages. Echocardiography suggested ventricular atrophy, valve dysfunction, decreased cardiac output, and lowered stroke volumes. Troponin I was significantly elevated in P361R-FD mice. Hearts from P361R-FD mice were found to have increased ceramide, cholesterol, and other lipids. Histopathological analysis of heart tissue from neonatal P361R-FD mice revealed lysosomal disruption as early as postnatal day 1. Finally, we report cardiac conduction, striated muscle contraction, and sphingolipid homeostasis gene expression differences during cardiac development in P361R-FD mice. In summary, we investigated the heart in a mouse model of ACDase deficiency, demonstrating that ACDase deficiency induced lysosomal dysfunction, sphingolipid and cholesterol imbalances, tissue disruption, and significant inflammation, leading to impaired cardiac function in these animals. NEW & NOTEWORTHY: This is the first characterization of cardiac function and histopathology in a mouse model of acid ceramidase deficiency. We report physiologic disruption suggestive of heart failure with preserved ejection fraction, progressive histopathology, and aberrant gene expression. We found significant lysosomal disruption at both neonatal and adult ages, suggesting a crucial role of acid ceramidase, and potentially ceramides, in cardiac development and function. [ABSTRACT FROM AUTHOR]

Environmental light exposure plays a role in the entrainment of the infant circadian rhythm, which is crucial for growth and development. This scoping review aims to evaluate existing literature linking the role of light exposure in the development of the infant circadian rhythm. This scoping review is conducted in accordance with the PRISMA-ScR guidelines. The search strategy was conducted in a total of six databases (PubMed, Cochrane Database of Systematic Reviews, Science Direct, Google Scholar, Taylor and Francis, and Wiley) as of August 2024. Reviews, narrative studies, observational studies, and experimental studies published from 2012 to 2024 were extracted. These studies discussed the role of light exposure on the development of infant circadian rhythm. A total of 25 studies were retrieved (3 observational studies, 6 experimental studies, and 16 reviews). Evidence showed that cycled lighting is beneficial for the entrainment of the infant circadian rhythm according to the 24-h light–dark cycle. Cycled lighting improved nighttime sleep and daytime wakefulness, promoting optimum growth and development. Limited experimental studies were conducted due to the ethical considerations of infants as study participants. Conclusions: Given the benefits of cycled lighting in the development of the circadian rhythm development, it should be implemented in both healthcare and home settings to promote optimum growth and development of the infant. [ABSTRACT FROM AUTHOR]

Background: A brachial plexus avulsion occurs when the nerve root separates from the spinal cord during birthing trauma, such as shoulder dystocia or a difficult vaginal delivery. A complete paralysis of the affected levels occurs post-brachial plexus avulsion. Despite being reported in 10–20% of brachial plexus birthing injuries, it remains poorly diagnosed during the acute stages of injury, leading to poor intervention approaches. The poor diagnosis of brachial plexus avulsion injury can be attributed to the currently unavailable biomechanics of brachial plexus avulsion. While the biomechanical properties of neonatal brachial plexus are available, the forces required to avulse a neonatal brachial plexus remain unknown. Methods: This study aims to provide detailed biomechanics of the required forces and corresponding strains for neonatal brachial plexus avulsion. Biomechanical tensile testing was performed on an isolated, clinically relevant piglet spinal cord and brachial plexus complex, and the required avulsion forces and strains were measured. Results: The reported failure forces and corresponding strains were 3.9 ± 1.6 N at a 27.9 ± 6.5% strain, respectively. Conclusion: The obtained data are required to understand the avulsion injury biomechanics and provide the necessary experimental data for computational model development that serves as an ideal surrogate for understanding complicated birthing injuries in newborns. [ABSTRACT FROM AUTHOR]

Anaerobe-targeted antibiotic (ATA) therapy may adversely impact the developing neonatal microbiome. We describe utilization patterns, potential indications, and related outcomes of ATA therapy in neonatal intensive care units across the United States over 13 years. While overall antibiotic use decreased, ATA use was unchanged. Potentially associated indications were inconsistent. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise that parents of infants who undergo cardiac surgery need preparation for home discharge • To familiarise yourself with the Congenital Heart Assessment Tool (CHAT), a parental early warning tool • To read about an e-learning resource designed to enhance the use of the CHAT by healthcare professionals. Parents need to be appropriately prepared by knowledgeable healthcare professionals before going home with their infant following cardiac surgery for complex congenital heart disease (CHD). A quality improvement project was undertaken between 2018 and 2021 to equip healthcare professionals including children’s cardiac nurses with the knowledge required to use the Congenital Heart Assessment Tool (CHAT) to teach parents how to monitor their infant at home. The project involved developing, implementing and evaluating an e-learning resource that included simulated scenarios captured on video. An online survey showed that users perceived the e-learning resource as having a positive effect on their understanding of complex CHD and their practice of preparing parents for discharge and home monitoring. [ABSTRACT FROM AUTHOR]

Aim: This study aims to analyse the developmental data from public health nurses (PHNs) to identify early indicators of neurodevelopmental disorders (NDDs) in young children using Bayesian network (BN) analysis to determine factor combinations that improve diagnosis accuracy. Methods: The study cohort was 501 children who underwent health checkups at 18 and 36‐month. Data included demographics, pregnancy, delivery, neonatal factors, maternal interviews, and physical and neurological findings. Diagnoses were made by paediatricians and child psychiatrists using standardised tools. Predictive accuracy was assessed by the receiver operating characteristic (ROC) curve analysis. Results: We identified several infant/toddler factors significantly associated with NDD diagnoses. Predictive factors included meconium‐stained amniotic fluid, 1 min Apgar score, and early developmental milestones. ROC curve analysis showed varying predictive accuracies based on evaluation timing. The 10‐month checkup was valid for screening but less reliable for excluding low‐risk cases. The 18‐month evaluation accurately identified children at NDD risk. Conclusion: The study demonstrates the potential of using developmental records for early NDD detection, emphasising early monitoring and intervention for at‐risk children. These findings could guide future infant mental health initiatives in the community. [ABSTRACT FROM AUTHOR]

Background: Cesarean deliveries have increased globally, with regional anesthesia being the preferred technique. Despite the advantages of the procedure, parturients experience apprehension regarding pain, mobility, and complications. The postoperative period following cesarean delivery can also be challenging. However, there is limited qualitative research exploring parturients' experiences with regional anesthesia for cesarean delivery and postoperative recovery. Methods: A qualitative study using in-depth interviews was conducted with 12 primiparous parturients who underwent cesarean delivery under regional anesthesia. Interviews explored knowledge, perceptions, and experiences regarding regional anesthesia, cesarean delivery, and postoperative recovery. Data were analyzed using thematic analysis. Results: Parturients in the study reported experiencing pregnancy-related complications necessitated for opting cesarean delivery instead of vaginal delivery. The study revealed substantial knowledge gaps among parturients regarding cesarean section (CS) and anesthesia. Their decision for CS was driven by prioritizing fetal safety over personal comfort. Parturients did not have many concerns about anesthesia and were focusing mainly on neonatal wellbeing. They had limited recollection of the anesthesia experience but vividly remembered the delivery process and postoperative pain. A strong desire for recovery to provide neonatal care was expressed. Despite challenges, parturients reported overall satisfaction with the CS experience and willingness to recommend it when medically indicated. Conclusion: The study highlights the need for comprehensive education on regional anesthesia, postoperative care, and coping strategies for parturients undergoing cesarean delivery. It emphasizes judicious use of cesarean delivery based on medical necessity while ensuring optimal maternal and neonatal outcomes. Further qualitative research with larger samples is recommended. [ABSTRACT FROM AUTHOR]

There is growing international evidence of the benefits of early perinatal palliative care for babies and their families. Despite this, inconsistency remains in ways care is provided by services including fetal medicine, maternity and neonatal services, and children's hospices. The aim of this study was to answer the question " What are the benefits and barriers to family-centered perinatal advance care planning from the perspective of professionals involved in the care of neonates and infants with life-limiting conditions? " Three focus groups comprising hospice practitioners were held across the UK. A lack of awareness of the role of hospices was described as the biggest barrier to referral to hospice services. Practitioners unanimously described having a physical presence alongside teams, as being the biggest contributor to improved multiagency working, facilitated through joint working and education provision. Early referral to hospice services, in parallel with curative services led to better outcomes and experiences of families, according to participants. [ABSTRACT FROM AUTHOR]

Background: Effective pain assessment in neonatal care is crucial for ensuring the well-being of newborns. However, barriers to its successful implementation persist. This study aims to identify the obstacles that hinder effective neonatal pain assessment by Neonatal Intensive Care Units (NICUs) nurses. Materials and Methods: This qualitative study was conducted using the method of conventional content analysis. Purposive sampling was employed from February to September 2023, selecting 14 female nurses working in NICUs of hospitals in Tehran and Karaj as participants. Indepth, semistructured interviews were conducted to collect the data. The software "MAXQDA" version 2016 was utilized for managing qualitative data. Results: Four main themes and eleven subthemes were identified: "Overtasked," "Discordant atmosphere," "Soulless care," and "Lack of awareness." Each of these main themes is further elaborated through the subsequent subthemes. Conclusions: This study found that the lack of knowledge and understanding of neonatal pain assessment tools, the busyness of nurses, lack of time, excessive documentation, and the inadequacy of staff relative to the number of newborns were the most significant obstacles to the assessment of newborn pain. Addressing these challenges is critical for optimal neonatal pain assessment and management, promoting the well-being of newborns. [ABSTRACT FROM AUTHOR]

Although stroke has long been recognized as an adult health problem that causes significant morbidity and mortality, it is also an important cause of brain injury in infants and children. The present article deals with this issue from the perspective of medical history. Physicians have tried throughout history to diagnose and treat this disease. One of the physicians who first accurately described this disease was Ibn Thalaj, who died in 975 AD. The hypotheses that he has raised about the causes of neonatal stroke, along with his recommendations for prevention and treatment, are intriguing. Exploring these hypotheses highlights the ongoing human endeavor to comprehend and combat diseases. [ABSTRACT FROM AUTHOR]

This study is to examine the vulnerabilities induced by neonatal drug delivery through developing innovative intravenous approaches centred on optimizing microchannel dimension ratios as a starting point. This research seeks the safety and accuracy in drug delivery for newborns by showing the capabilities of the microchannel-based devices surpassing traditional limits. The research analyzes the effect of different microchannel aspect ratio on drug delivery accuracy using a trade-off between precision and velocity in the medication of neonates. Going for a more effective therapy with lesser side effects the study explores mechanisms of constant drug delivery, sequential delivery and responsiveness to environmental cues. Proposed method includes using microchannel to control drug delivery rate with high precision and reliability. Essential parts like microchannel heights, widths and depths are discussed to tackle the pain of delivering the drug molecules precisely. Methodologies are a release study, finite element analysis, and microchannel fluid model where velocity and flow rate distribution in drug delivery are investigated in detail. This study's primary outcomes of this study are aimed at an improved drug delivery system and elucidating the contributions of microchannel components to the same. This study illustrates microchannels as a powerful tool in neonatal drug delivery with dimension ratios as the essential criterion for efficacy and safety. The optimization of microchannel aspect ratios enabled drug delivery precision increase by 20%, decreased drug wastage by 15%, and improved flow rates by 25%. These alterations reduced the settling time by 30% while reducing the pressure drop by 10%, thus enhancing the efficiency and safety of neonatal care. The study findings have made significant steps toward the resolution of issues arising from transport of therapeutic molecules to newborns. [ABSTRACT FROM AUTHOR]

Abstract Overweight and obesity are significant public health concerns, affecting pregnant women and potentially leading to numerous complications for both maternal and neonatal health. The aim of this study is to estimate how pre-pregnancy overweight and obesity, as well as gestational weight gain, influence pregnancy outcomes and neonatal health in Poland. The study material consisted of data from 2878 women aged 16–46 years from hospitals in Warsaw and Krosno. The analysis included data on the course of singleton pregnancies and the biological condition of the newborns, correlated with pre-pregnancy Body Mass Index (BMI) and gestational weight gain (GWG), which were compared to the standards set by the Institute of Medicine (IOM). Factor that significantly influences pre-pregnancy BMI and GWG is the number of pregnancies. For first-born women pre-pregnancy BMI was significantly lower than that of women giving birth for the second, third and subsequent times (ANOVA p 25 significantly increased the odds of perinatal injury and breastfeeding difficulties.

Abstract Objective To review the available literature concerning the definition of neonatal status epilepticus (SE) and/or seizure burden. Methods The International League Against Epilepsy Neonatal Task Force performed a scoping review of the definitions of neonatal SE. Following a systematic literature review, articles were screened and data were abstracted regarding: (1) article characteristics (author identification, publication year, journal name, digital object identifier, title, objective, and study design); (2) cohort characteristics (sample size, gestational age, seizure etiology); (3) definition of SE and/or seizure burden; and (4) the method used to identify and classify SE, including routine EEG (EEG), continuous EEG monitoring (cEEG), amplitude‐integrated EEG (aEEG), or clinical features. Results The scoping review yielded 44 articles containing a definition of neonatal SE. Studies mainly included infants with hypoxic–ischemic encephalopathy or neonates considered at risk for seizures. SE identification and classification most often relied on cEEG. The majority of studies based the definition of SE on seizure duration, including summed duration of seizures comprising ≥50% of any 1‐h epoch, recurrent seizures for >50% of the total recording time, or either electrographic seizures lasting >30 min and/or repeated electrographic seizures totaling >50% in any 1‐h period. Seizure burden was reported in 20 studies, and the most commonly used approach assessed total seizure burden, defined as total duration of EEG seizures in minutes. Sixteen studies assessed the relationship between seizure burden and outcomes, and most identified a significant association between higher seizure burden and unfavorable outcomes. Significance This scoping review demonstrates a substantial variation in neonatal SE definitions across the literature. The most common definitions were based around a 30‐min seizure duration criterion, but evidence was insufficient to support that 30 min was a cutoff defining prolonged seizures or that seizures exceeding this burden were more likely to be pharmacoresistant or associated with worse outcomes. As a next step, the Neonatal Task Force intends to develop a standardized approach to assessing and describing neonatal seizure burden and defining neonatal SE. Plain Language Summary Prolonged seizures are a neurologic emergency, if untreated, can lead to permanent injury or death. In adults and children, seizures lasting longer than 30 min are believed to cause brain damage. However, it is not clear if this definition can be applied to neonates. The International League Against Epilepsy Neonatal Taskforce performed a scoping literature review which identified 44 articles containing a definition of neonatal status epilepticus. In this article, the authors reviewed the current used definitions for prolonged seizures in neonates to establish a relationship between seizure duration and neurological outcome. As a next step, the Neonatal Task Force intends to develop a standardized approach to assessing and describing neonatal seizure burden and defining neonatal SE.

Abstract Background Digestive disorders are one of the main health problems in suckling piglets. The correct visual identification of feces in suckling piglets is an important tool for the diagnosis of enteric diseases. The aim of the present observational study was to analyze different physicochemical parameters of the feces of suckling piglets aged 0 to 21 days: visual appearance (color and consistency), fecal dry matter (FDM) content and pH. A total of 482 fecal samples were collected and visually classified into six categories: meconium, colostrum stage feces and 4 further scores according to the degree of consistency: 0 = form; 1 = pasty; 2 = liquid; and 3 = watery feces. The percentage of FDM was estimated by two drying methods, oven and microwave, doing duplicates in each one to evaluate methods, and both were compared. Results The most frequent colors of each feces category were dark green or dark brown for meconium; orange for colostrum; formed feces were mostly ocher and for the rest of the feces, the colors varied predominantly cream and ocher. Regarding FDM, liquid and watery categories had no statistically significant differences between them; meconium and colostrum feces FDM were not statistically different from pasty feces. The correlation coefficient between the FDM values of the duplicate analyses of the samples by both methods (oven and microwave) was very high (> 0.988). Importantly, no differences were found while comparing the results between both methods (p = 0.078), and the correlation coefficient between all samples analyzed with both methods was very high (> 0.98). Meconium was the only one that differed significantly from the rest in terms of pH. Conclusion The physicochemical study of the feces of suckling piglets including color, FDM and pH allowed the establishment of an objective fecal score to characterize the stools in this age group.

Infection during the perinatal period can adversely affect brain development, predispose infants to ischemic stroke and have lifelong consequences. We previously demonstrated that diet enriched in n-3 polyunsaturated fatty acids (n-3 PUFA) transforms brain lipid composition in the offspring and protects the neonatal brain from stroke, in part by blunting injurious immune responses. Critical to the interface between the brain and systemic circulation is the vasculature, endothelial cells in particular, that support brain homeostasis and provide a barrier to systemic infection. Here, we examined whether maternal PUFA-enriched diets exert reprograming of endothelial cell signalling in postnatal day 9 mice after modeling aspects of infection using LPS. Transcriptome analysis was performed on microvessels isolated from brains of pups from dams maintained on 3 different maternal diets from gestation day 1: standard, n-3 enriched or n-6 enriched diets. Depending on the diet, in endothelial cells LPS produced distinct regulation of pathways related to immune response, cell cycle, extracellular matrix, and angiogenesis. N-3 PUFA diet enabled higher immune reactivity in brain vasculature, while preventing imbalance of cell cycle regulation and extracellular matrix cascades that accompanied inflammatory response in standard diet. Cytokine analysis revealed a blunted LPS response in blood and brain of offspring from dams on n-3 enriched diet. Analysis of cerebral vasculature in offspring in vivo revealed no differences in vessel density. However, vessel complexity was decreased in response to LPS at 72 h in standard and n-6 diets. Thus, LPS modulates specific transcriptomic changes in brain vessels of offspring rather than major structural vessel characteristics during early life. N-3 PUFA-enriched maternal diet in part prevents an imbalance in homeostatic processes, alters inflammation and ultimately mitigates changes to the complexity of surface vessel networks that result from infection. Importantly, maternal diet may presage offspring neurovascular outcomes later in life.

Background: Hemolytic disease of the newborn (HDN) is a rare condition with the potential for high morbidity. Local Problem: Practice at a large maternity care center did not align with the American Academy of Pediatrics (AAP) revised hyperbilirubinemia guidelines. Methods: A pre/post-implementation design with Plan-Do-Study-Act cycles was used. Interventions: A clinical pathway was implemented to improve timely evaluation of newborns at risk for HDN due to a positive maternal antibody using cord blood. Results: Cord blood testing increased among the subset of newborns who did not meet collection criteria prior to the practice change (pre: 0% n = 7, post: 39% n = 23). Missed opportunities to test cord blood occurred less frequently post (35 versus 26 days between missed opportunities). Feasibility data identified the need for educational and clinical tools. Conclusions: A clinical pathway and tailored tools support the AAP recommendation. Electronic health record supports could bolster future efforts. [ABSTRACT FROM AUTHOR]

Abstract Introduction In clinical settings, digital dashboards display medical data, with the aim of identifying trends and signals. In so doing these contribute towards improving service delivery and care within hospitals. It is not clear whether the utility of perinatal health equity dashboards could be used to identify health inequality trends that could potentially impact on health service delivery, care and public health interventions. This study aims to evaluate the implementation of health inequality dashboards that address disparities in maternal and neonatal outcomes, with a specific focus on identifying key challenges encountered during their deployment and use in healthcare settings. Methods Three databases, namely Embase, CINAHL, and Medline were searched to identify relevant studies in English Language published between 2010 and 2022. All findings were reported according to PRISMA guidelines for scoping reviews. Results Of 670 identified articles, only 13 met the inclusion criteria. The study identified three key themes: dashboard functionality, data accuracy, and challenges in collecting health inequality data. Dashboards were used to visualize disparities, with functionalities focusing on specific audiences, contents, and utility. Issues with data completeness, standardization, and challenges in collecting consistent health inequality data, especially from diverse ethnic groups, hindered the accurate tracking of maternal and neonatal disparities. Conclusion The use of perinatal health inequality dashboards is a critical step forward in optimizing maternal and neonatal care by providing targeted interventions. However, further research is needed to assess their long-term impact on reducing health inequalities, while addressing challenges related to data accuracy, completeness, and standardization to improve their effectiveness.

Abstract Heart transplantation remains the ultimate treatment strategy for neonates and children with medically refractory end-stage heart failure and utilization of donors after circulatory death (DCD) can expand th donor pool. We have previously shown that mitochondrial transplantation preserves myocardial function and viability in neonatal swine DCD hearts to levels similar to that observed in donation after brain death (DBD). Herein, we sought to investigate the transcriptomic and proteomic pathways implicated in these phenotypic changes using ex situ perfused swine hearts. Pathway analysis showed that ATP binding, voltage-gated K channel activity involved in cardiac cell muscle contraction and ribosomal RNA biogenesis were upregulated in the mitochondrial transplantation group, while mitochondria were the predicted source. Promotion of ribosome biogenesis and downregulation of apoptosis were the overlapping mechanisms between transcriptomic and proteomic alterations. Moreover, we showed that mitochondrial transplantation modulates ischemic transcriptomic and proteomic profiles to that of non-ischemia through the mitochondria. Replication of these findings in human in vivo experiments is warranted.

Abstract Neonatal hypothermia is a significant global problem of neonates with huge contribution of neonatal morbidity and mortality. Recognizing major contributors of neonatal hypothermia is very important in designing preventing methods which was the objective of our study. This was an institution-based cross-sectional study conducted on 339 neonates admitted to Neonatal Intensive Care Unit of University of Gondar Comprehensive Specialized Hospital over 6months. Study participants were selected using systematic random sampling techniques and both bivariate and multivariate logistic regression analyses were used to identify contributors and p-value of

Abstract Objectives To compare the effect of lung recruitment using high frequency ventilation versus volume targeted ventilation on duration of intubation as well as its effect on lung inflammation in preterm infants with respiratory distress syndrome. Methods The study was conducted on a total of 40 preterm infants, 34 weeks gestational age or less, having RDS that needed intubation and mechanical ventilation within the first 72 h after their birth at the NICU of Mansoura University Children’s Hospital during the period from July 2020 to July 2022. Infants included were randomly assigned into two groups, Group A who were subjected to LRM using HFOV (20 cases) and Group B who were subjected to LRM using VTV/AC (20 cases). TGF-β1 level was measured in BAL samples of all studied infants at two time points; before lung recruitment maneuver and at day 5 after lung recruitment or just before extubation if extubation occurs earlier than 5 days. Results Lung recruitment maneuver had no significant effect on time to extubation. Both groups showed no significant difference in rate of prematurity complications nor delta change of TFG-β1 level in tracheal aspirate of those preterm infants measured before lung recruitment and five days after recruitment or at extubation when extubation occurred earlier. Conclusions Lung recruitment maneuver was not associated with significant difference between both groups of preterm infants. The results obtained from our study, being the first of its kind to compare the effect of lung recruitment, provide a promising research area for further investigations.

Abstract Background The postpartum period is associated with an increased risk of maternal mental disorders. The combined effect of having the mother's infant admitted to a tertiary hospital in a low-resource setting and the need to exclusively breastfeed the infant may exaggerate this risk. This study aimed to determine the breastfeeding support provided to mothers whose infants were hospitalised in Nigerian tertiary hospital nurseries and the prevalence of common mental health disorders among this population. Methods This was a national cross-sectional study involving mothers of hospitalised infants from eleven Nigerian tertiary hospitals between May and August 2022. To assess mothers' mental health and breastfeeding support, we utilised the WHO self-reporting Questionnaire 20 and an adapted WHO/UNICEF ten-step breastfeeding support package. Results Of the 1,120 mothers recruited from neonatal nurseries in the six geopolitical zones in Nigeria, only 895 had a complete dataset for analysis. The mean age of the mothers was 29.9 ± 6.2; with 54.7% belonging to the low-socioeconomic class. Most of the mothers (835, 93.3%) received antenatal care, and 591: 66.0% were delivered at term. Overall, less than half (427; 47.7%) of the mother received optimal breastfeeding support. One in every four, 216; 24.0% of nursing mothers (95% CI: 21.235 to 26.937%) had common mental disorders (CMD). Pre-pregnant mental health disorders were reported in 41; 4.6% of the nursing mothers. Overall, the lowest performing areas of breastfeeding support were family-centred care (198, 22.1%), practical skill demonstration in the ward (n = 279, 31.2%), and antenatal clinics (n = 294, 32.8%). CMDs were significantly associated with the healthcare provider's practical breastfeeding skill demonstration and the provision of storage facilities for breastmilk and family-centered-care. Across Nigeria's six geopolitical zones, there was an inverse relationship between optimal breastfeeding support and the proportion of mothers with CMDs. The northern zone provided better breastfeeding support and had fewer CMDs than the southern region of the country. Conclusion Common mental disorders are prevalent among nursing mothers in Nigerian tertiary hospital nurseries, and they are inversely related to breastfeeding support. Urgently required in tertiary hospitals for improved and sustainable breastfeeding practices are a focus on family-centred care and enhanced health workers’ practical breastfeeding support skills.

Abstract Neonatal diabetes mellitus (NDM), defined as diabetes with an onset during the first 6 months of life, is a rare form of monogenic diabetes. The initial publications on this condition began appearing in the second half of the 1990s and quite surprisingly, the search for new NDM genes is still ongoing with great vigor. Between 2018 and early 2024, six brand new NDM‐genes have been discovered (CNOT1, FICD, ONECUT1, PDIA6, YIPF5, ZNF808) and three genes known to cause different diseases were identified as NDM‐genes (EIF2B1, NARS2, KCNMA1). In addition, NDM cases carrying mutations in three other genes known to give rise to diabetes during childhood have been also identified (AGPAT2, BSCL2, PIK3R1). As a consequence, the list of NDM genes now exceeds 40. This genetic heterogeneity translates into many different mechanism(s) of disease that are being investigated with state‐of‐the‐art methodologies, such as induced pluripotent stem cells (iPSC) and human embryonic stem cells (hESC) manipulated with the CRISPR technique of genome editing. This diversity in genetic causes and the pathophysiology of diabetes dictate the need for a variety of therapeutic approaches. The aim of this paper is to provide an overview on recent achievements in all aspects of this area of research.

Objective: The aim of this study was to investigate the work stress and burnout levels of neonatal intensive care nurses and the factors affecting them. Method: This descriptive study was conducted with 270 (73%) of 372 neonatal intensive care nurses who were working in neonatal intensive care units in Şanlıurfa province. Data were collected electronically with Google Form using the descriptive characteristics form, Maslach burnout inventory, and general work stress scale. The linear regression (enter) method was used to evaluate the data. Results: It was found that nurses working in the neonatal intensive care unit experienced work stress slightly above medium level and emotional burnout at a level close to medium. It was also found that the sense of personal accomplishment was low along with depersonalization. A strong positive correlation was found between the scores of nurses on the general work stress scale and their scores on the Maslach burnout inventory subscales. It was also found that emotional burnout, depersonalisation and sense of personal accomplishment experienced by nurses explained 70.3% of their general work stress. Conclusion: Burnout and work stress levels of neonatal intensive care nurses were affected by many factors such as gender, marital status, previous education, shift system, and length of service. It is recommended that regular meetings should be held with nurses, prioritised problems should be considered and psychological support should be provided to nurses working in specialized units such as neonatal intensive care.

Introduction: Sacrococcygeal Teratomas (SCTs) are the most common extragonadal germ cell tumours during the neonatal period. Although they are typically benign, these tumours carry a significant risk of malignant transformation if not treated promptly. Early diagnosis through clinical evaluation, laboratory tests, and radiological investigations, followed by surgical excision, is crucial in preventing malignancy and ensuring better outcomes. Aim: To comprehensively analyse SCTs by examining the demographic distribution, clinical features, radiological characteristics, and histopathological profiles of affected patients. Materials and Methods: This retrospective descriptive observational study was conducted in the Department of Paediatric Surgery of Pandit Bhagwat Dayal Sharma, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India, from June 2018 to May 2022 involving 11 patients diagnosed with SCT. These patients underwent thorough clinical evaluations, laboratory investigations, and radiological assessments. All patients were treated using standard posterior surgical excision techniques. Postoperative follow-up included both short- and long-term monitoring, focusing on wound infections, recurrence, and metastasis. The data were analysed using Statistical Packages for Social Sciences (SPSS) software version 25.0. Continuous variables were presented as mean±Standard Deviation (SD) or median and range, depending on the distribution. Categorical variables were expressed as frequencies and percentages. Results: Out of 11 patients, there were nine females and two males. The median age at presentation was 18 days, ranging from one day to three years. The majority of tumours belonged to Altman type 1a7 (63.6%), while types 2 and 3 each constituted two cases (18.2%). Clinical presentation predominantly involved a lower back mass Since birth in 10 (90.9%) cases. Histopathological Examination (HPE) revealed mature teratomas in 9 (81.8%) cases, with immature teratoma and yolk sac tumour each accounting for 9.1% (1 case each). Notably, early presentations correlated with mature teratomas, whereas delayed presentations were associated with yolk sac tumours. One patient with a Type 3 lesion experienced recurrence and metastasis during the follow-up period. Conclusion: The SCTs are predominantly found in neonates, with a strong female predominance. Early detection generally results in a favourable outcome, while delayed diagnosis is associated with an increased risk of malignancy, recurrence, and poorer prognosis. Careful follow-up is essential, particularly for patients with higher-risk tumour types and later-stage presentations.

Abstract Background Sierra Leone has reduced neonatal mortality rates(NMR) in recent years. Despite this progress, disparities in newborn survival persist across socio-economic and geographic areas. This study examined the inequalities in neonatal mortality rates in Sierra Leone between 2008 and 2019. Methods We utilized data from the Sierra Leone Demographic Health Survey rounds conducted in 2008, 2013, and 2019. We used the World Health Organisation Health Equity Assessment Toolkit to calculate simple measures of inequality (Difference, and Ratio), and complex measures of inequality (Population Attributable Risk, and Population Attributable Fraction). Inequality in neonatal mortality rate was calculated on six stratifiers: maternal age, maternal economic status, maternal level of education, place of residence, sex of the child, and sub-national province. Results Neonatal mortality rate decreased in Sierra Loene from 48.6 deaths per 1,000 live births in 2008 to 29.6 deaths per 1,000 live births in 2019. There was an increase in age-related inequality from a Difference of 0.7 deaths per 1,000 live births in 2008 to 4.3 deaths per 1,000 live births in 2019. Economic inequality decreased from a Difference of 26.8 deaths per 1,000 live births in 2008 to -3.4 deaths per 1,000 live births in 2019. Inequality in education decreased from a Difference of 4.6 deaths per 1,000 live births in 2008 to -4.2 deaths per 1,000 live births in 2019. Inequality increased from a Difference of − 0.5 deaths per 1,000 live births in 2008 to -4.2 deaths per 1,000 live births in 2019 for place of residence. For the child’s sex, the inequality increased from a Difference of − 7.9 deaths per 1,000 live births in 2008 to -11.1 deaths per 1,000 live births in 2019. Provincial inequality increased slightly from a Difference of 14.0 deaths per 1,000 live births in 2008 to 14.4 deaths per 1,000 live births in 2019. Conclusion The findings show a decline in the national neonatal mortality rate from 2008 to 2019, indicating improvements in healthcare and maternal support. While economic and educational inequalities have decreased, especially in education, sustaining these gains is essential for equitable healthcare access. Despite this progress, inequalities based on age, residence, child’s sex, and province still exist, and have increased between 2008 and 2019. Policymakers should focus on targeted programs for vulnerable age groups and sexes, and develop geographical strategies to ensure uniform improvements in neonatal health.

Background: Neonatal resuscitation is a critical skill that requires regular training and practice; however, traditional training methods are often limited by accessibility, cost and engagement. Serious games (SGs) have emerged as a promising educational tool to address these challenges. This systematic review assesses the effectiveness of SGs in neonatal resuscitation education. Objectives: This systematic review assesses the effectiveness of SGs in neonatal resuscitation education. Methods: This systematic review followed the preferred reporting items for systematic reviews and meta-analysis guidelines and utilized a comprehensive search strategy across multiple databases (PubMed, Scopus, Web of Science, Embase, Cochrane and ProQuest) using keywords and MeSH terms related to neonatal resuscitation and SGs. Studies published in English up to July 25, 2024, focusing on SGs for neonatal resuscitation training were included. Two independent reviewers screened titles, abstracts, and full texts, resolving disagreements through discussion. Results: SGs were as effective as video lectures in improving neonatal resuscitation performance. Also, remote digital SGs provided interactive and enjoyable learning experiences for anesthesiologists and pediatric trainees. Paramedics and registered nurses significantly improved neonatal resuscitation performance and knowledge using SGs. Nursing students exhibited increased knowledge, problem-solving abilities and self-confidence with virtual reality-based SGs. Conclusions: SGs demonstrate promise as a complementary tool for neonatal resuscitation education. They can enhance knowledge acquisition, and skills development, and potentially improve motivation and engagement. However, further research is needed to optimize game design, investigate long-term learning outcomes, and assess skills transfer to clinical practice. Integrating SGs with traditional simulation-based training methods could offer a comprehensive and effective approach to training healthcare professionals in this critical skill set.

Background: Incontinentia pigmenti (IP) is a rare X-linked dominantly inherited genetic skin disorder in which most male infants cannot survive. The clinical manifestation is mainly characterized by a characteristic rash, which may also involve multiple extracutaneous organs. Case Presentation: We reported three children with pigmentary incontinence, and a literature review was conducted to elaborate on the clinical manifestations of various systems in patients with IP. Conclusions: IP is a disease that involves multiple systems and patients with IP are likely to develop serious ocular and neurologic complications. Once diagnosed, neurologists, ophthalmologists, and dentists must consult and evaluate patients multidisciplinaryly. Early intervention and adherence to lifelong follow-up are needed.

Abstract Background Preterm birth is the leading cause of childhood mortality, and respiratory distress syndrome is the predominant cause of these deaths. Early continuous positive airway pressure is effective in high-resource settings, reducing the rate of continuous positive airway pressure failure, and the need for mechanical ventilation and surfactant. However, most deaths in preterm infants occur in low-resource settings without access to mechanical ventilation or surfactant. We hypothesize that in such settings, early continuous positive airway pressure will reduce the rate of failure and therefore preterm mortality. Methods This is a mixed methods feasibility and acceptability, single-center pilot randomized control trial of early continuous positive airway pressure among infants with birthweight 800–1500 g. There are two parallel arms: (i) application of continuous positive airway pressure; with optional oxygen when indicated; applied in the delivery room within 15 min of birth; transitioning to bubble continuous positive airway pressure after admission to the neonatal unit if Downes Score ≥ 4 (intervention), (ii) supplementary oxygen at delivery when indicated; transitioning to bubble continuous positive airways pressure after admission to the neonatal unit if Downes Score ≥ 4 (control). A two-stage consent process (verbal consent during labor, followed by full written consent within 24 h of birth) and a low-cost third-party allocation process for randomization will be piloted. We will use focus group discussions and key informant interviews to explore the acceptability of the intervention, two-stage consent process, and trial design. We will interview healthcare workers, mothers, and caregivers of preterm infants. Feasibility will be assessed by the proportion of infants randomized within 15 min of delivery; the proportion of infants in the intervention arm receiving CPAP within 15 min of delivery; and the proportion of infants with primary and secondary outcomes measured successfully. Discussion This pilot trial will enhance our understanding of methods and techniques that can enable emergency neonatal research to be carried out effectively, affordably, and acceptably in low-resource settings. This mixed-methods approach will allow a comprehensive exploration of parental and healthcare worker perceptions, experiences, and acceptance of the intervention and trial design. Trial registration The study is registered on the Pan African Clinical Trials Registry (PACTR) PACTR202208462613789. Registered 08 August 2022. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23888 .